Design and baseline characteristics of the Veterans Affairs Non-Q-Wave Infarction Strategies In-Hospital (VANQWISH) trial. VANQWISH Trial Research Investigators.
OBJECTIVE
The Veterans Affairs Non-Q-Wave Infarction Strategies In-Hospital (VANQWISH) trial was designed to compare outcomes of patients with a non-Q wave myocardial infarction (NQMI) who were randomized prospectively to an early "invasive" strategy versus an early "conservative" strategy. The primary objective was to compare early and late outcomes between the two strategies using a combined trial end point (all-cause mortality or nonfatal infarction) during at least 1 year of follow-up.


BACKGROUND
Because of the widely held view that survivors of NQMI are at high risk for subsequent cardiac events, management of these patients has become more aggressive during the last decade. There is a paucity of data from controlled trials to support such an approach, however.


METHODS
Appropriate patients with a new NQMI were randomized to an early "invasive" strategy (routine coronary angiography followed by myocardial revascularization, if feasible) versus an early "conservative" strategy (noninvasive, predischarge stress testing with planar thallium scintigraphy and radionuclide ventriculography), where the use of coronary angiography and myocardial revascularization was guided by the development of ischemia (clinical course or results of noninvasive tests, or both).


RESULTS
A total of 920 patients were randomized (mean follow-up 23 months, range 12 to 44). The mean patient age was 61 +/- 10 years; 97% were male; 38% had ST segment depression at study entry; 30% had an anterior NQMI; 54% were hypertensive; 26% had diabetes requiring insulin; 43% were current smokers; 43% had a previous acute myocardial infarction; and 45% had antecedent angina within 3 weeks of the index NQMI.


CONCLUSIONS
Baseline characteristics were compatible with a moderate to high risk group of patients with an NQMI.
Ferry
D R
DR
Jerry L. Pettis Veterans Affairs Medical Center and Loma Linda University School of Medicine, California, USA.
O'Rourke
R A
RA
Blaustein
A S
AS
Crawford
M H
MH
Deedwania
P C
PC
Carson
P E
PE
Pepine
C J
CJ
Thomas
R G
RG
Hlatky
M A
MA
Leppo
J A
JA
Iwane
M K
MK
Kleiger
R E
RE
Zoble
R G
RG
Dai
H
H
Chow
B K
BK
Lavori
P W
PW
Boden
W E
WE
D000787:Angina Pectoris / Q000150:complications; D002423:Cause of Death; D017023:Coronary Angiography; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004562:Electrocardiography; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy; D009204:Myocardial Revascularization; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D019275:Radiopharmaceuticals; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate; D013794:Thallium Radioisotopes; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes